| NPI | 1992904627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA MD.202882) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME101200) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 0000041854) | |
| Enumeration Date | 2007-07-12 |
| Last Update Date | 2018-02-14 |