| NPI | 1629241336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VT 042.0012073) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60346655) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: ID M-12281) | |
| Enumeration Date | 2008-04-02 |
| Last Update Date | 2017-05-08 |