| NPI | 1649561499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 44403) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 232461) |
| Enumeration Date | 2011-04-27 |
| Last Update Date | 2011-07-27 |