| NPI | 1003827007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 29957) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: CO 46267) |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2022-10-06 |