| NPI | 1376521740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: PA OS004127L) |
| Additional Taxonomies | 2085U0001X Radiology Diagnostic Ultrasound (Licence: MO R8N04) |
| Enumeration Date | 2006-01-05 |
| Last Update Date | 2016-05-17 |