| NPI | 1346438801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A99697) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 54583) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 66307) | |
| Enumeration Date | 2007-10-10 |
| Last Update Date | 2024-09-10 |