| NPI | 1083651186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CO 36986) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NE 25088) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: KS 04-36338) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: HI 17555) | |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2020-12-22 |