| NPI | 1831342799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WY 9415A) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: ID M-14819) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MT 78054) | |
| Enumeration Date | 2008-10-23 |
| Last Update Date | 2020-03-04 |