| NPI | 1760621288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: MN 52300) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 104378) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 52300) | |
| Enumeration Date | 2009-02-05 |
| Last Update Date | 2011-06-28 |