| NPI | 1144245432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085N0700X (Licence: PR 14711) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PR 14711) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2019-03-13 |