| NPI | 1619189875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD443030) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MT181850) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2013-04-24 |