| NPI | 1487649760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 209887) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NH 6341) |
| Enumeration Date | 2005-09-13 |
| Last Update Date | 2007-12-21 |