| NPI | 1578544797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 1809551205) |
| Additional Taxonomies | 2085N0700X (Licence: UT 180955-1205) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: ID M-11498) | |
| Enumeration Date | 2005-11-07 |
| Last Update Date | 2012-08-30 |