| NPI | 1871772707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 6020069-1205) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101247071) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NV 14129) | |
| Enumeration Date | 2007-10-27 |
| Last Update Date | 2011-12-13 |