| NPI | 1063668622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085B0100X Radiology, Body Imaging (Licence: LA MD206062) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MS T-2124) |
| Enumeration Date | 2008-08-14 |
| Last Update Date | 2015-11-18 |