| NPI | 1134204571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD01117E) |
| Additional Taxonomies | 2085N0700X Radiology Neuroradiology (Licence: PA MD011170E) |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2007-10-04 |