| NPI | 1063400752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: OR MD16370) |
| Additional Taxonomies | 2085R0203X Radiology, Therapeutic Radiology (Licence: OR MD16370) |
| Enumeration Date | 2005-10-07 |
| Last Update Date | 2007-12-01 |