| NPI | 1922048107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: UT 177323-1205) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: ID M-8390) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2012-11-13 |