| NPI | 1972692853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PR 14618) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL 85926) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2010-07-08 |