| NPI | 1508861840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MT 6953) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 32427) |
| Enumeration Date | 2005-06-14 |
| Last Update Date | 2009-08-26 |