| NPI | 1043311202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2022033043) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KS 0446872) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD00031208) | |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2023-02-01 |