| NPI | 1114185303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MT 12055) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI pending) |
| Enumeration Date | 2008-05-25 |
| Last Update Date | 2013-12-30 |