| NPI | 1790734762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME97805) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 49091) |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2012-02-24 |