| NPI | 1003860719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: ME 017280) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 24823) |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2007-08-27 |