| NPI | 1851395735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 40661) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 44394) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: IA 34306) | |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2015-09-22 |