| NPI | 1639268659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101046659) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: VA 0101046659) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2009-07-28 |