| NPI | 1639185044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CO 37953) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: WY 7597A) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: NE 21193) | |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2015-09-16 |