| NPI | 1285736462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 43280) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO T2005018779) |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2011-12-20 |