| NPI | 1144213141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MS 07661) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA 05908R) |
| Enumeration Date | 2005-08-24 |
| Last Update Date | 2015-05-20 |