| NPI | 1104810761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D31159) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NH 12737) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VT 042-0011034) | |
| Enumeration Date | 2005-09-09 |
| Last Update Date | 2015-06-24 |