| NPI | 1821035874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 47896) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 30568) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2009-12-28 |