NPI | 1205010600 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OK 7162) |
Additional Taxonomies | 2085R0001X (Licence: KY C2851) |
2085R0202X Radiology, Diagnostic Radiology (Licence: WA OP61576409) | |
2085R0202X Radiology, Diagnostic Radiology (Licence: NY 230723) | |
2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MB06425900) | |
Enumeration Date | 2007-12-20 |
Last Update Date | 2025-03-31 |