| NPI | 1255305173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD00048942) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 44747) |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2011-04-21 |