| NPI | 1194808394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: IA 37861) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: SC 23902) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: NE 24188) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: CA A99351) | |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2020-11-03 |