| NPI | 1164544235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD454573) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: TX N3201) |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2015-05-20 |