| NPI | 1649240334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 32944) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G71064) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NV 4904) | |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2022-09-16 |