| NPI | 1578636304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA 311671) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NM MD2008-0641) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WA 00036046) | |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2019-03-07 |