| NPI | 1902219801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MA 292867) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital |
| Enumeration Date | 2014-06-09 |
| Last Update Date | 2022-09-28 |