| NPI | 1790902765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PR 8402) |
| Additional Taxonomies | 2085U0001X Radiology, Diagnostic Ultrasound (Licence: PR 8402) |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2009-08-19 |