| NPI | 1609871896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 45406) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA 35952) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 49397) | |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2017-12-28 |