| NPI | 1265631287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 27752) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: NE 27752) |
| 2085U0001X Radiology, Diagnostic Ultrasound (Licence: NE 27752) | |
| Enumeration Date | 2007-07-11 |
| Last Update Date | 2014-09-24 |