| NPI | 1821074329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101255614) |
| Additional Taxonomies | 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: GA 047791) |
| Enumeration Date | 2005-12-16 |
| Last Update Date | 2014-06-02 |