| NPI | 1376607150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 47442) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GU M-2209) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2003014155) | |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2023-02-22 |