| NPI | 1396963336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301084116) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 52796) |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2010-09-24 |