| NPI | 1053648956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 282N00000X General Acute Care Hospital (Licence: MA 242608) |
| Additional Taxonomies | 261QM1200X Clinic/Center Magnetic Resonance Imaging (MRI) (Licence: MA 242608) |
| Enumeration Date | 2009-11-13 |
| Last Update Date | 2014-07-02 |