| NPI | 1710941612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD00035868) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 043916) |
| Enumeration Date | 2006-04-17 |
| Last Update Date | 2011-11-15 |