| NPI | 1942394382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085B0100X Radiology Body Imaging (Licence: MA 205780) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MA 205780) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2007-07-08 |