| NPI | 1407199730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD.MD.61598409) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 62229) |
| Enumeration Date | 2013-04-04 |
| Last Update Date | 2025-01-23 |