| NPI | 1891902573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TX L4722) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 20437) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: GA 053725) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: NC 200001536) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: OK 25154) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: TN 36330) | |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2010-04-23 |