| NPI | 1932119542 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 60365) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2005037044) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NM 2002-0144) | |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2016-06-01 |