| NPI | 1366447401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 64989) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 53135) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 30739) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 0057079) | |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2022-07-18 |