| NPI | 1053477562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085U0001X Radiology, Diagnostic Ultrasound (Licence: FL me62121) |
| Additional Taxonomies | 2085U0001X Radiology, Diagnostic Ultrasound (Licence: MO 32620) |
| 2085U0001X Radiology, Diagnostic Ultrasound (Licence: OH 35.03391) | |
| 2085U0001X Radiology, Diagnostic Ultrasound (Licence: AK 5035) | |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2007-07-08 |