| NPI | 1164423745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101023208) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 19885) |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2012-01-20 |