| NPI | 1659374262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: GA 051890) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NY 202673) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: AL 26644) | |
| Enumeration Date | 2005-05-27 |
| Last Update Date | 2016-11-10 |