| NPI | 1629024989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX N1607) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2006008741) |
| 174400000X Specialist (Licence: OK 26730) | |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2014-05-15 |