| NPI | 1174542179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 48785) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: RI MD13183) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 223682) | |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2025-02-25 |