| NPI | 1144262668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 104786) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WY 7201A) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: ID M-11787) | |
| Enumeration Date | 2006-06-11 |
| Last Update Date | 2022-12-16 |