| NPI | 1356667547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX Q5909) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WY 17662C) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NE CP1129) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CO CDR.0004569) | |
| Enumeration Date | 2010-04-13 |
| Last Update Date | 2025-03-06 |