| NPI | 1518120575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX Q7459) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 75620) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: GU MC-190) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: ND 20432) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: IA MD-52303) | |
| Enumeration Date | 2008-07-09 |
| Last Update Date | 2024-08-19 |