| NPI | 1861655284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085N0700X (Licence: WA 60180404) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 60272661205) |
| Enumeration Date | 2008-07-07 |
| Last Update Date | 2018-04-24 |