| NPI | 1093762288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME89430) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 160219) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2016-04-11 |