| NPI | 1003013830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 47534) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 43115) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WV 22458) | |
| Enumeration Date | 2007-06-27 |
| Last Update Date | 2021-03-14 |