| NPI | 1174810824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MI 4301098675) |
| Additional Taxonomies | 2085B0100X Radiology Body Imaging (Licence: MI 4301098675) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: MI 4301097675) | |
| Enumeration Date | 2011-07-01 |
| Last Update Date | 2018-03-17 |