| NPI | 1619298387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 54874) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 252657) |
| Enumeration Date | 2010-06-17 |
| Last Update Date | 2018-03-17 |