| NPI | 1992049621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME135334) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 57605) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 056367) | |
| Enumeration Date | 2012-11-19 |
| Last Update Date | 2023-08-16 |