| NPI | 1720094139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CO 41377) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NE 22603) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: WY 7598A) | |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2015-09-14 |