| NPI | 1245411958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CO 52616) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NE 29962) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: MA 239318) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: HI MD19075) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: KS 04-39909) | |
| Enumeration Date | 2007-11-21 |
| Last Update Date | 2022-12-09 |