| NPI | 1346457298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: ID M-10927) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: UT 7245122-1205) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2010-03-23 |