| NPI | 1114902525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TX TEMP) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: FL OS9472) |
| Enumeration Date | 2005-12-08 |
| Last Update Date | 2008-01-03 |