| NPI | 1033109681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 44247) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WY 5850A) |
| Enumeration Date | 2005-10-25 |
| Last Update Date | 2018-04-26 |