| NPI | 1578822979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: LA 331623) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: LA 390200000) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: TX R2581) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: MS 30301) | |
| Enumeration Date | 2012-05-07 |
| Last Update Date | 2022-11-03 |