| NPI | 1902889934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CO 49165) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 30222) |
| Enumeration Date | 2005-11-23 |
| Last Update Date | 2014-09-08 |