| NPI | 1710270731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA OS017906) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA OT014203) |
| Enumeration Date | 2011-05-24 |
| Last Update Date | 2017-01-03 |