| NPI | 1265437503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AR C5927) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 248394) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2007012499) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NV 12478) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME 103764) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX N3718) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35-080633) | |
| Enumeration Date | 2005-06-14 |
| Last Update Date | 2010-05-27 |