| NPI | 1154634681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 17199) |
| Additional Taxonomies | 2085N0904X Radiology, Nuclear Radiology (Licence: WI 17199) |
| Enumeration Date | 2010-07-26 |
| Last Update Date | 2010-07-26 |