| NPI | 1891955027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MT 12859) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: UT 6805164-1205) |
| Enumeration Date | 2008-06-11 |
| Last Update Date | 2012-07-24 |