| NPI | 1265597413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX J3915) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 02202) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 5101012082) | |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2011-04-18 |