| NPI | 1164719621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MS 24251) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MS T-2477) |
| Enumeration Date | 2011-07-06 |
| Last Update Date | 2016-10-07 |