| NPI | 1043697840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO DR.0066339) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WY TL6696) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 33575) | |
| Enumeration Date | 2015-04-30 |
| Last Update Date | 2021-06-28 |