| NPI | 1598797896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: ND 12676) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 3063410) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 51530) | |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2013-11-11 |