| NPI | 1982847463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2016-00024) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 39403) |
| Enumeration Date | 2009-04-13 |
| Last Update Date | 2017-12-20 |