| NPI | 1174511919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AK 6038) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AR E1817) |
| Enumeration Date | 2005-10-06 |
| Last Update Date | 2013-02-05 |