| NPI | 1558579763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2008013747) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2003015143) |
| Enumeration Date | 2007-05-19 |
| Last Update Date | 2016-02-01 |