| NPI | 1841302007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD00048235) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 044452) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2012-01-10 |