| NPI | 1982732228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MS 20145) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AL 25508) |
| Enumeration Date | 2007-02-28 |
| Last Update Date | 2017-01-17 |