| NPI | 1306890017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 250208) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A79458) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 35017) | |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2023-10-25 |