| NPI | 1821087255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MO R8D54) |
| Additional Taxonomies | 2085B0100X Radiology Body Imaging (Licence: MO R8D54) |
| Enumeration Date | 2005-10-18 |
| Last Update Date | 2012-02-07 |