| NPI | 1699872226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: RI MD04613) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 38964) |
| Enumeration Date | 2006-09-17 |
| Last Update Date | 2007-10-10 |