| NPI | 1760470058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MA 37202) |
| Additional Taxonomies | 2085B0100X Radiology Body Imaging (Licence: MA 37202) |
| Enumeration Date | 2005-10-11 |
| Last Update Date | 2012-08-02 |