| NPI | 1376633552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: VA 0101228204) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: CA G73385) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: WI 36212-020) | |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2007-07-08 |