| NPI | 1235392416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD466785) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KS 7629) |
| Enumeration Date | 2008-07-08 |
| Last Update Date | 2019-06-05 |