| NPI | 1821223728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MA 249146) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MA L-239295) |
| Enumeration Date | 2009-05-20 |
| Last Update Date | 2012-02-09 |