| NPI | 1962472464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 5040) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA OP00002140) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA 20A 9538) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 971) | |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2009-08-20 |