| NPI | 1629254305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AR E-7022) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 001469) |
| Enumeration Date | 2008-01-13 |
| Last Update Date | 2018-07-13 |