| NPI | 1073954236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 255662) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 71917) |
| Enumeration Date | 2013-07-16 |
| Last Update Date | 2014-07-07 |