| NPI | 1306966007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OK 26931) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN MD0000041318) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX M9529) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: AR E-4938) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MS 18723) | |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2016-03-15 |