| NPI | 1043414642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TX M8427) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: TX BP1-0022835) |
| Enumeration Date | 2007-06-14 |
| Last Update Date | 2011-03-04 |