| NPI | 1609865948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AK 6006) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 4985210-1205) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WY 4597A) | |
| Enumeration Date | 2005-10-19 |
| Last Update Date | 2014-11-26 |