| NPI | 1225358047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: RI MD14242) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MA 274143) |
| Enumeration Date | 2010-06-03 |
| Last Update Date | 2019-03-19 |