| NPI | 1346292877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 147384-1) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME 0057183) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2013-04-29 |