| NPI | 1386039758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301502049) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AR E-14076) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: HI MD-22249) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 64808) | |
| Enumeration Date | 2015-04-02 |
| Last Update Date | 2024-05-16 |