| NPI | 1831103845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: SC MD 33626) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MN 48854) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2012-01-27 |