| NPI | 1629059423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO DR.0054806) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: HI MD - 12628) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD 60071848) | |
| Enumeration Date | 2005-11-09 |
| Last Update Date | 2015-02-25 |