| NPI | 1598846727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MI 4301044765) |
| Additional Taxonomies | 2085B0100X Radiology Body Imaging (Licence: MI 4301044765) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2012-03-19 |