| NPI | 1891735510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 161991-1205) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: ID M-8428) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2012-09-04 |