| NPI | 1174529507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TX L6717) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: DE C1-0026249) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: CA C182649) | |
| Enumeration Date | 2005-06-21 |
| Last Update Date | 2024-08-20 |