| NPI | 1114244001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN MD0000045856) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MS 20426) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: AR E-6410) | |
| Enumeration Date | 2010-04-30 |
| Last Update Date | 2012-06-28 |