| NPI | 1689791493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101245471) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A73178) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX M5291) | |
| Enumeration Date | 2007-03-25 |
| Last Update Date | 2011-07-22 |