| NPI | 1346449709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: AZ R990) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: IA 4250) |
| Enumeration Date | 2007-07-16 |
| Last Update Date | 2012-06-15 |