| NPI | 1063723971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NC 2014-02268) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: SC 32830) |
| Enumeration Date | 2010-06-24 |
| Last Update Date | 2017-12-20 |