| NPI | 1962406710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 19804) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 20179) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: IA 26083) | |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2010-04-21 |