| NPI | 1861479503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: PR 15846) |
| Additional Taxonomies | 2085U0001X Radiology Diagnostic Ultrasound (Licence: PR 15846) |
| Enumeration Date | 2005-12-23 |
| Last Update Date | 2010-12-23 |