| NPI | 1265743041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 055006) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 5506) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 253495) | |
| Enumeration Date | 2010-06-28 |
| Last Update Date | 2018-08-02 |