| NPI | 1912903881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 21754) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN MD0000039305) |
| Enumeration Date | 2005-06-24 |
| Last Update Date | 2015-10-27 |