| NPI | 1841291861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: ID M9573) |
| Additional Taxonomies | 2085U0001X Radiology, Diagnostic Ultrasound (Licence: MN 25618) |
| 2085B0100X Radiology, Body Imaging (Licence: MN 25618) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 25618) | |
| Enumeration Date | 2005-08-02 |
| Last Update Date | 2010-02-05 |