| NPI | 1144331745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: WV 16786) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD-034164-L) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2007-07-08 |