| NPI | 1316923535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60082335) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 041299) |
| Enumeration Date | 2005-12-20 |
| Last Update Date | 2011-12-08 |