| NPI | 1184982167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO DR.0061905) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX Q4764) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 49730) | |
| Enumeration Date | 2012-04-27 |
| Last Update Date | 2023-11-17 |