| NPI | 1255363842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 71804) |
| Additional Taxonomies | 2085N0700X (Licence: MA 71804) |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2013-07-08 |