| NPI | 1083989362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CO DR.0065457) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: WY 13302A) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: TX R7944) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: NE 33216) | |
| Enumeration Date | 2012-03-20 |
| Last Update Date | 2021-06-05 |