| NPI | 1508887316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 48553) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 055692) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2012-08-16 |