| NPI | 1932512811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: ID M-15070) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ R74548) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ R74548) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MT MED-PHYS-LIC-80820) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WY 12620A) | |
| Enumeration Date | 2014-06-09 |
| Last Update Date | 2020-05-06 |