| NPI | 1932454477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA MD012775) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: ME MD14784) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NH 10249) | |
| Enumeration Date | 2012-07-20 |
| Last Update Date | 2012-07-20 |