| NPI | 1376543264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX H7915) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AR E3201) |
| Enumeration Date | 2005-07-21 |
| Last Update Date | 2007-07-10 |