| NPI | 1912937822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 156626) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 028265) |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2012-04-12 |