| NPI | 1821094079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 29728) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 31047) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: IA 22916) | |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2016-02-15 |