| NPI | 1053390146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085U0001X Radiology, Diagnostic Ultrasound (Licence: MA 220062) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 220062) |
| Enumeration Date | 2006-01-17 |
| Last Update Date | 2012-09-12 |