| NPI | 1669444337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AL 00007989) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME90164) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 0000-20942) | |
| Enumeration Date | 2006-02-06 |
| Last Update Date | 2011-11-02 |