| NPI | 1902831555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME96881) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: FL MFC1414) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2008-03-21 |