| NPI | 1114122090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085B0100X Radiology Body Imaging (Licence: MA 228968) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MA 228968) |
| Enumeration Date | 2007-06-19 |
| Last Update Date | 2023-05-04 |