| NPI | 1902828064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MS 18382) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: AL 00012287) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: TN MD0000019591) | |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2007-07-08 |