| NPI | 1386885796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: MA 229188) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 49706) |
| Enumeration Date | 2009-03-13 |
| Last Update Date | 2011-06-13 |