| NPI | 1780021824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 94703) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 278547) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: RI MD16204) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: RI LP02824) | |
| Enumeration Date | 2013-05-30 |
| Last Update Date | 2023-04-21 |