| NPI | 1750363578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101054495) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 200200807) |
| Enumeration Date | 2005-11-17 |
| Last Update Date | 2012-10-08 |