| NPI | 1255318986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: PR 011026) |
| Additional Taxonomies | 2085U0001X Radiology Diagnostic Ultrasound (Licence: PR 011026) |
| Enumeration Date | 2005-12-23 |
| Last Update Date | 2007-07-08 |