| NPI | 1205977998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 7298607-1205) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MT 7655) |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2013-09-23 |