| NPI | 1912126616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301087969) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 54726) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 66265) | |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2021-01-06 |