| NPI | 1083719496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AK 4985) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 13487) |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2007-07-08 |