| NPI | 1447255500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 33381) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 44431) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: IA 34354) | |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2021-05-21 |