| NPI | 1902881428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AK 5361) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA GFE 64721) |
| Enumeration Date | 2005-12-07 |
| Last Update Date | 2007-07-08 |