| NPI | 1144201930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 65674) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 65674-20) |
| Enumeration Date | 2005-11-08 |
| Last Update Date | 2022-05-26 |