| NPI | 1962502591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA MD.015552) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA 015552) |
| Enumeration Date | 2006-09-24 |
| Last Update Date | 2010-09-02 |