| NPI | 1376528315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD418327) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: CA A81037) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: CT 34824) | |
| Enumeration Date | 2005-12-13 |
| Last Update Date | 2021-03-30 |