| NPI | 1235164724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 27466) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AL 24169) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 055309) | |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2022-03-30 |