| NPI | 1134119019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2007-01030) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 37383) |
| Enumeration Date | 2005-10-24 |
| Last Update Date | 2014-02-13 |