| NPI | 1487887766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085B0100X Radiology, Body Imaging (Licence: GA 079285) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME152117) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 270632) | |
| Enumeration Date | 2009-09-02 |
| Last Update Date | 2021-11-02 |