| NPI | 1073574349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: SD 1629) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WY 3100A) |
| Enumeration Date | 2006-03-28 |
| Last Update Date | 2012-08-06 |