| NPI | 1306094289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301097599) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: WA FE60022162) |
| 2085B0100X Radiology, Body Imaging (Licence: MI 4301097599) | |
| Enumeration Date | 2008-09-04 |
| Last Update Date | 2010-12-09 |