| NPI | 1992805089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 20234) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 21409) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2009-01-09 |