| NPI | 1710141767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 74184) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MS 22941) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 235770) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MS 741-L) | |
| Enumeration Date | 2008-07-17 |
| Last Update Date | 2023-05-31 |