| NPI | 1851593768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OK 24059) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 48782) |
| Enumeration Date | 2007-06-03 |
| Last Update Date | 2015-07-27 |