| NPI | 1508933847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 40891) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MS 18742) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A101781) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: LA MD.202860) | |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2019-01-18 |