| NPI | 1487853859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MS 19880) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MS T1824) |
| Enumeration Date | 2007-07-16 |
| Last Update Date | 2015-12-08 |