| NPI | 1174740005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 231127) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 42588) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A89915) | |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2024-04-04 |