| NPI | 1609939396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MS 20611) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: FL TRN7961) |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2009-07-08 |