| NPI | 1619198801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: SD 8399) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: NC 201000986) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301085978) | |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2012-06-05 |