| NPI | 1063549335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OR MD08533) |
| Additional Taxonomies | 174400000X Specialist (Licence: OR MD09995) |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2010-07-29 |