| NPI | 1487884953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301094950) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60506991) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OR MD170012) | |
| Enumeration Date | 2009-07-20 |
| Last Update Date | 2021-01-04 |