| NPI | 1396727491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL FL) |
| Additional Taxonomies | 174400000X Specialist (Licence: MA 212349) |
| Enumeration Date | 2005-11-16 |
| Last Update Date | 2011-04-08 |