| NPI | 1316055031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX G0733) |
| Additional Taxonomies | 2085U0001X Radiology, Diagnostic Ultrasound (Licence: TX G0733) |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2007-07-08 |