| NPI | 1639175144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: UT 6821016-1205) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: ID M-11041) |
| Enumeration Date | 2005-06-21 |
| Last Update Date | 2012-09-07 |