| NPI | 1144519745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WY 11800A) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE COPS130) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CO CDR.0003611) | |
| Enumeration Date | 2011-04-04 |
| Last Update Date | 2024-06-17 |