| NPI | 1043345762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: VA 0101247551) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: UT 5758852-1205) |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2010-09-09 |