| NPI | 1083751044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NC 2011-00108) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MD D65295) |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2011-12-07 |