| NPI | 1508897422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: OR MD15506) |
| Additional Taxonomies | 2085N0904X Radiology Nuclear Radiology (Licence: OR MD15506) |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2007-11-29 |