| NPI | 1457514341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 55109) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 5748) |
| Enumeration Date | 2008-07-09 |
| Last Update Date | 2012-09-13 |