| NPI | 1417232711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 076239) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: GA 76239) |
| Enumeration Date | 2011-10-18 |
| Last Update Date | 2019-06-25 |