| NPI | 1306834270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX M6368) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL OS8130) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OK 4582) | |
| Enumeration Date | 2005-10-13 |
| Last Update Date | 2015-10-16 |