| NPI | 1740490655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA 202098) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301080056) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2007013152) | |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2014-02-02 |