| NPI | 1306820162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD058608L) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 053927) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: ME MD20481) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME123941) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 202292) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WV 26357) | |
| Enumeration Date | 2005-12-05 |
| Last Update Date | 2015-06-12 |