| NPI | 1104848506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 02983) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO DR.0053540) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: IN 02002431A) | |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2024-09-16 |