| NPI | 1164571048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301089644) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MT182251) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2012-02-29 |