| NPI | 1730192063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 33771) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A89752) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME94709) | |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2022-04-08 |