| NPI | 1760418586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: WY 5165A) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: CO 40274) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: NE 21265) | |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2007-07-09 |