| NPI | 1467434985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 37880) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 35531) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: IA 36007) | |
| Enumeration Date | 2005-11-18 |
| Last Update Date | 2022-08-30 |