| NPI | 1477533503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MO 31858) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: KS 14363) |
| Enumeration Date | 2006-01-17 |
| Last Update Date | 2007-07-08 |