| NPI | 1831215318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN MD0000005282) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 38281) |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2007-07-08 |