| NPI | 1154310589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: RI MD09365) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 77298) |
| Enumeration Date | 2005-10-18 |
| Last Update Date | 2019-03-25 |