| NPI | 1003077256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A120788) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 45868) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME113630) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 7675702-1205) | |
| Enumeration Date | 2008-06-20 |
| Last Update Date | 2012-08-14 |