| NPI | 1215095401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME0061197) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 174072) |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2008-05-11 |