| NPI | 1699865543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME97372) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: HI MD 13941) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2018-08-14 |