| NPI | 1306132725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO CDRH.0062728) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE CP1005) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WY 13173A) | |
| Enumeration Date | 2011-06-23 |
| Last Update Date | 2025-01-20 |