| NPI | 1659552750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D70052) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX M7247) |
| Enumeration Date | 2007-11-16 |
| Last Update Date | 2011-01-29 |