| NPI | 1770565319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA 320973) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 55067) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD457434) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A86683) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 45629) | |
| Enumeration Date | 2005-11-18 |
| Last Update Date | 2019-11-05 |