| NPI | 1710904370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX N0254) |
| Additional Taxonomies | 174400000X Specialist (Licence: MS 18525) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2011-09-28 |