| NPI | 1760534762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 1819) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 5101005349) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA 20A4212) | |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2008-04-02 |