| NPI | 1992736797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME52228) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME0052228) |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2013-02-19 |