| NPI | 1427280460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 249969) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: MA 240331) |
| 2085U0001X Radiology, Diagnostic Ultrasound (Licence: MA 240331) | |
| Enumeration Date | 2009-08-10 |
| Last Update Date | 2017-05-22 |