| NPI | 1386873008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 263065) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: RI 14568) |
| Enumeration Date | 2009-07-02 |
| Last Update Date | 2015-06-22 |