| NPI | 1881910297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX N7219) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KS 0433216) |
| Enumeration Date | 2010-04-09 |
| Last Update Date | 2011-01-06 |