| NPI | 1144206806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101283380) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO DR.0043173) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 33600) | |
| Enumeration Date | 2005-12-15 |
| Last Update Date | 2024-10-30 |