| NPI | 1871562280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA 33927) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 23253) |
| Enumeration Date | 2006-03-16 |
| Last Update Date | 2007-07-08 |