| NPI | 1790704724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 50104-020) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: IL 036-110027) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301088229) | |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2013-08-22 |