| NPI | 1619963857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 034563) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: CT 03-4563) |
| Enumeration Date | 2005-09-22 |
| Last Update Date | 2013-03-13 |