| NPI | 1912905530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL OS9236) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: FL OS9236) |
| Enumeration Date | 2005-07-08 |
| Last Update Date | 2008-01-22 |