| NPI | 1508815978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: RI MD12005) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MD D61496) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: MA 261389) | |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2024-03-15 |