| NPI | 1548313588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 236282) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 225716) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2016-04-06 |