| NPI | 1902821754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 18681) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 5997) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2011-12-12 |