| NPI | 1710080031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: ME DO2667) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 058309) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WA OP00001889) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 1011) | |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2022-08-09 |