| NPI | 1306833983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RM1200X Internal Medicine Magnetic Resonance Imaging (MRI) (Licence: PR 12100) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: PR 12100) |
| 2085B0100X Radiology Body Imaging (Licence: PR 12100) | |
| Enumeration Date | 2005-09-29 |
| Last Update Date | 2007-07-08 |