| NPI | 1225007446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 38428) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NM 82-314) |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2012-07-31 |