| NPI | 1811974553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2005-01288) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: NC 200501288) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 200501288) | |
| Enumeration Date | 2005-12-23 |
| Last Update Date | 2010-09-22 |