| NPI | 1841250040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 163182-1205) |
| Additional Taxonomies | 174400000X Specialist (Licence: UT 1631821205) |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2011-02-17 |