| NPI | 1114308574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NE 30785) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: CO DR.0065466) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: WY 13366A) | |
| Enumeration Date | 2015-06-11 |
| Last Update Date | 2023-10-03 |