| NPI | 1558519173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NV 26326) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2008020474) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 061422) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101237960) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NM MD2008-0634) | |
| Enumeration Date | 2008-09-08 |
| Last Update Date | 2024-12-05 |