| NPI | 1205820842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: ID O-0402) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: DE C2-0006432) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA 20A9408) | |
| Enumeration Date | 2005-09-09 |
| Last Update Date | 2022-12-28 |