| NPI | 1164445417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: KY 40954) |
| Additional Taxonomies | 2085U0001X Radiology Diagnostic Ultrasound (Licence: FL ME94876) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2017-03-07 |