| NPI | 1770586356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 46660) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 44575) |
| Enumeration Date | 2005-05-27 |
| Last Update Date | 2011-03-10 |