| NPI | 1831192640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI wc058039) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: MI wc058039) |
| 2085N0904X Radiology, Nuclear Radiology (Licence: MI wc058039) | |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2010-01-27 |