| NPI | 1073729711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: SC 30790) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: GA 059359) |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2014-02-13 |