| NPI | 1184698573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: SC 37621) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: WA OP60653343) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: KY 03683) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: TN 2295) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: IN 02002876A) | |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2020-01-13 |