| NPI | 1902094899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 37114) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 46015-020) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301091016) | |
| Enumeration Date | 2007-10-04 |
| Last Update Date | 2014-01-28 |