| NPI | 1427030410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX M4742) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL 89214) |
| Enumeration Date | 2005-11-16 |
| Last Update Date | 2015-01-12 |