| NPI | 1407902786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2011-01755) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: HI 13792) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: RI 14829) | |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2023-05-15 |