| NPI | 1154541373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2012-01007) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA 2113) |
| Enumeration Date | 2007-04-27 |
| Last Update Date | 2012-06-21 |