| NPI | 1508815184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AK 5825) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60316126) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX P9205) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.151118) | |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2024-05-28 |