| NPI | 1780764399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MT 4480) |
| Additional Taxonomies | 2085N0904X (Licence: MT 4480) |
| 2085U0001X Radiology, Diagnostic Ultrasound (Licence: MT 4480) | |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2009-08-19 |