| NPI | 1689842643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME105715) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: NC 2008-00116) |
| Enumeration Date | 2008-02-13 |
| Last Update Date | 2013-08-05 |