| NPI | 1134126105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 57793) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: MA 57793) |
| Enumeration Date | 2005-07-05 |
| Last Update Date | 2017-12-12 |