| NPI | 1063403251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA OS011831) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 224067) |
| Enumeration Date | 2005-11-04 |
| Last Update Date | 2007-07-08 |