| NPI | 1487659496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA 09720R) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: LA MD.09720R) |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2008-08-19 |