| NPI | 1508956517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME 57602) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX K8744) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2016-09-14 |