| NPI | 1578664769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL 23629) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 019952) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2008-07-14 |