| NPI | 1861712531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME152539) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD457204) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 56885) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 286603) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA10459500) | |
| Enumeration Date | 2010-06-04 |
| Last Update Date | 2024-05-20 |