| NPI | 1417982877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MI 4301051273) |
| Additional Taxonomies | 174400000X Specialist |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2016-06-13 |