| NPI | 1124293568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME106416) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 248347-1) |
| Enumeration Date | 2008-04-28 |
| Last Update Date | 2012-04-20 |