| NPI | 1679725451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME156498) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY P61321) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 064246) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 056535) | |
| Enumeration Date | 2008-10-13 |
| Last Update Date | 2022-07-29 |