| NPI | 1831122761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 55920) |
| Additional Taxonomies | 174400000X Specialist (Licence: GA 55920) |
| 174400000X Specialist (Licence: NC 200401172) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 200401172) | |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2014-04-25 |