| NPI | 1841428463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD 2838) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 71031) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KY C0684) | |
| Enumeration Date | 2009-06-23 |
| Last Update Date | 2022-08-05 |