| NPI | 1720250228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MA 236117) |
| Additional Taxonomies | 207RM1200X Internal Medicine Magnetic Resonance Imaging (MRI) (Licence: MA 236117) |
| 2085B0100X Radiology Body Imaging (Licence: MA 236117) | |
| 2085U0001X Radiology Diagnostic Ultrasound (Licence: MA 236117) | |
| Enumeration Date | 2008-03-25 |
| Last Update Date | 2023-07-20 |