| NPI | 1154509339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 051760) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 341225) |
| Enumeration Date | 2008-02-09 |
| Last Update Date | 2016-11-08 |