| NPI | 1245258011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX M8847) |
| Additional Taxonomies | 174400000X Specialist (Licence: VA 0101239154) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2016-06-08 |