| NPI | 1396722393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX N1068) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 44379) |
| Enumeration Date | 2005-12-30 |
| Last Update Date | 2009-06-10 |