| NPI | 1255591608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 007551) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: HI DOS-1300) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0102203545) | |
| Enumeration Date | 2008-06-10 |
| Last Update Date | 2019-01-23 |