| NPI | 1962504167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 066768) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OK 25131) |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2014-06-06 |