| NPI | 1932333853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 215606) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MA 253656) |
| Enumeration Date | 2009-05-06 |
| Last Update Date | 2015-09-18 |