| NPI | 1710004916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 39338) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 29827) |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2007-07-08 |