| NPI | 1639151285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: SD 7685) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: ND 9874) |
| Enumeration Date | 2005-11-18 |
| Last Update Date | 2013-02-06 |