| NPI | 1629282884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 256182) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 57129) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 14277) | |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2014-04-02 |