NPI | 1639379209 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2085B0100X Radiology, Body Imaging (Licence: LA MD.205289) |
Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC LL30044) |
2085R0202X Radiology, Diagnostic Radiology (Licence: TN MD0000046071) | |
Enumeration Date | 2007-07-23 |
Last Update Date | 2012-10-26 |