| NPI | 1255314118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AL 17904) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 55080) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 00417) | |
| Enumeration Date | 2005-11-23 |
| Last Update Date | 2023-08-10 |