| NPI | 1003904541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 226434) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 226434) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2011-12-01 |