| NPI | 1285711671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: GA 067510) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: SC 27905) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2012-05-17 |