| NPI | 1114929965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D0030871) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 10357) |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2007-11-13 |