| NPI | 1114017852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: VA 0101251848) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: SC LL28862) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2012-06-12 |