| NPI | 1417029737 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA MD12764R)  | 
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA 12764R)  | 
| Enumeration Date | 2006-11-14 | 
| Last Update Date | 2011-02-03 |