| NPI | 1649457235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MT191722) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: PA MT191722) |
| Enumeration Date | 2008-01-25 |
| Last Update Date | 2008-01-25 |