| NPI | 1689744161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PR 11542) |
| Additional Taxonomies | 2085U0001X Radiology, Diagnostic Ultrasound (Licence: FL ME 0005742) |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2017-02-03 |