| NPI | 1205836699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME101578) |
| Additional Taxonomies | 174400000X Specialist (Licence: GA 049913) |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2017-08-30 |