| NPI | 1154673713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301072946) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 200300815) |
| Enumeration Date | 2012-10-08 |
| Last Update Date | 2013-11-22 |