| NPI | 1548528003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A167654) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GU M-2117) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.128802) | |
| Enumeration Date | 2012-05-02 |
| Last Update Date | 2022-12-16 |