| NPI | 1366552523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX P1580) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 215378) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2011-12-16 |