| NPI | 1265571137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: ND 11835) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OK 24568) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2012-05-04 |