| NPI | 1013128073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 065294) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX N8438) |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2012-04-28 |