| NPI | 1336129915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D0041134) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 31369) |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2014-11-18 |