| NPI | 1730162785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME58344) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 20040011975) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 200400267) | |
| Enumeration Date | 2005-11-23 |
| Last Update Date | 2014-05-12 |