| NPI | 1386678290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 020421) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: CT 020421) |
| 2085U0001X Radiology, Diagnostic Ultrasound (Licence: CT 020421) | |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2010-05-18 |