| NPI | 1922072875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME0050576) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA MD054903L) |
| Enumeration Date | 2006-02-16 |
| Last Update Date | 2009-02-17 |