| NPI | 1023155223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX M6682) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 5413741-1205) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: AR E-5324) | |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2010-06-14 |