| NPI | 1689732091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL 30781) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME30781) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2011-12-14 |