| NPI | 1790959427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX m9705) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 0061149) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WA 60927882) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: HI 16386) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA C158890) | |
| Enumeration Date | 2008-04-14 |
| Last Update Date | 2020-08-18 |