| NPI | 1043208903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: IA 38402) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: IA SP159) |
| Enumeration Date | 2005-10-13 |
| Last Update Date | 2009-05-08 |