| NPI | 1124173653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 064225) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 17686) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2009-00651) | |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2021-10-16 |