| NPI | 1114905007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: WA MD00043543) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MI 4301503494) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: ID 12343) | |
| Enumeration Date | 2006-01-03 |
| Last Update Date | 2025-01-28 |