| 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 |