| NPI | 1962623447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO DR-50945) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: IL 125-051980) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: IA 4176) | |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2013-06-24 |