| NPI | 1093746760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME107754) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 09816) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2012-10-29 |