| NPI | 1861459125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 039007) |
| Additional Taxonomies | 2085U0001X Radiology, Diagnostic Ultrasound (Licence: CT 037007) |
| Enumeration Date | 2006-04-28 |
| Last Update Date | 2008-06-23 |