| NPI | 1790739944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 052513) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA MD.09993R) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MS 17765) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: AL MD.24892) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G63955) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 036090) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX L6315) | |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2009-12-15 |