| NPI | 1689655888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NV 14089) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 38325) |
| Enumeration Date | 2005-11-07 |
| Last Update Date | 2011-11-08 |