| NPI | 1194915413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: IA 40301) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD441790) |
| Enumeration Date | 2007-08-01 |
| Last Update Date | 2012-07-02 |