| NPI | 1073539029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 23136) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: KY 30444) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2008-07-30 |