| NPI | 1376797084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 42953) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 55979) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NM MD2023-1276) | |
| Enumeration Date | 2008-11-07 |
| Last Update Date | 2023-09-14 |