| NPI | 1043204464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AL 00018981) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 33861) |
| Enumeration Date | 2005-08-31 |
| Last Update Date | 2007-09-26 |