| NPI | 1407829922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX M3211) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA MD426932) |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2012-08-15 |