| NPI | 1720100100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD438731) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 229111) |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2012-01-09 |