| NPI | 1285769539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: OR MD160550) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MI 4301084458) |
| Enumeration Date | 2007-02-23 |
| Last Update Date | 2013-11-21 |