| NPI | 1417905522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085B0100X Radiology, Body Imaging (Licence: AZ 19560) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME139580) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2020-07-14 |