| 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 |