| NPI | 1972502367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TX D3992) |
| Additional Taxonomies | 2085B0100X Radiology Body Imaging (Licence: TX D3992) |
| 2085U0001X Radiology Diagnostic Ultrasound (Licence: TX D3992) | |
| Enumeration Date | 2005-07-18 |
| Last Update Date | 2012-08-15 |