| NPI | 1881685121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: IA 33458) |
| Additional Taxonomies | 208600000X Surgery (Licence: IA 33458) |
| 2085B0100X Radiology Body Imaging (Licence: IA 33458) | |
| 2085U0001X Radiology Diagnostic Ultrasound (Licence: IA 33458) | |
| Enumeration Date | 2005-11-04 |
| Last Update Date | 2011-08-11 |