| NPI | 1457336729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 6062305-1205) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: ID M-9192) |
| 2085U0001X Radiology, Diagnostic Ultrasound (Licence: UT 6062305-1205) | |
| Enumeration Date | 2005-12-09 |
| Last Update Date | 2012-08-30 |