| NPI | 1700108040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: ID M-10761) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: WA MD60110392) |
| Enumeration Date | 2010-02-26 |
| Last Update Date | 2010-02-26 |