| NPI | 1205941408 |
|---|---|
| Doing Business As | |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 47157) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OK 23109) |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2007-07-08 |