| NPI | 1326469263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL UO3496) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA 308731) |
| Enumeration Date | 2013-12-19 |
| Last Update Date | 2018-05-15 |