| NPI | 1063854354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME153593) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD444023) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.125435) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2018-02790) | |
| Enumeration Date | 2013-07-26 |
| Last Update Date | 2023-03-27 |