| NPI | 1992861488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2011-00238) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 060197) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101251595) | |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2012-05-17 |