| NPI | 1578563987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TX L2308) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: AR E3287) |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2011-04-08 |