| NPI | 1295995926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX N2655) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 51721) |
| Enumeration Date | 2008-06-16 |
| Last Update Date | 2010-11-02 |