| NPI | 1508015207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NM MD2022-1142) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME111493) |
| Enumeration Date | 2008-09-17 |
| Last Update Date | 2022-09-12 |