| NPI | 1821263096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME120193) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60346562) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 53111) | |
| Enumeration Date | 2008-04-28 |
| Last Update Date | 2023-02-21 |