| NPI | 1184680266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: SC 17542) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: GA 052950) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2007-10-18 |