| NPI | 1154351922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 82215) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: MA 82215) |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2017-01-11 |