| NPI | 1174615496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD056207L) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G62863) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2008-04-25 |