| NPI | 1447576905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 051446) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 261856) |
| Enumeration Date | 2010-04-08 |
| Last Update Date | 2016-10-28 |