| NPI | 1104809953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 2085N0904X Radiology Nuclear Radiology (Licence: FL CERTIFICATION #01371) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME14159) |
| Enumeration Date | 2005-11-25 |
| Last Update Date | 2007-07-09 |