| NPI | 1134203722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MA 247286) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: VT 0420011172) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: NY 236567) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: RI MD13226) | |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2014-02-18 |