| NPI | 1275587487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: IA 36809) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NE 20123) |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2011-10-19 |