| NPI | 1558305052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MO 114865) |
| Additional Taxonomies | 2085B0100X Radiology Body Imaging (Licence: MO 114865) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2013-01-25 |