| NPI | 1083654065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085B0100X Radiology, Body Imaging (Licence: UT 276179-1205) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: ID M-10293) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 276179-1205) | |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2012-11-13 |