| NPI | 1356568810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A93239) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WV 30268) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101271610) | |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2021-06-09 |