| NPI | 1336334481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PR 020777) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 250224) |
| Enumeration Date | 2007-09-12 |
| Last Update Date | 2019-05-31 |