| NPI | 1053390849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 47413) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: ND 8428) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 28524) | |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2023-12-28 |