| NPI | 1770578742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 52677) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NH 6934) |
| Enumeration Date | 2005-09-15 |
| Last Update Date | 2014-03-07 |