| NPI | 1053659672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA mD02843R) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX D1111) |
| Enumeration Date | 2013-01-17 |
| Last Update Date | 2013-01-17 |