| NPI | 1649312935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TX M8736) |
| Additional Taxonomies | 2085B0100X Radiology Body Imaging (Licence: OH A98598) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2012-08-15 |