| NPI | 1215159447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0102202576) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA OT011323) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2011-04-13 |