| NPI | 1841490422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA 026461) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 41862) |
| Enumeration Date | 2007-07-20 |
| Last Update Date | 2009-03-30 |