| NPI | 1114149788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 30580) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2005-00415) |
| 2085N0904X (Licence: SC 30580) | |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2014-02-14 |