| NPI | 1205813045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CO 36073) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NE 25171) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: KS 04-36482) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: HI MD17546) | |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2022-12-09 |