| NPI | 1932121787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 6591897-1205) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101239883) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: ID M-10309) | |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2012-10-10 |