| NPI | 1376533430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME71932) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 32742) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 36351) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 217235) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301077268) | |
| Enumeration Date | 2005-10-28 |
| Last Update Date | 2007-07-08 |