| NPI | 1871599092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 037292) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 231984) |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2018-03-17 |