| NPI | 1477512747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME54914) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 44229) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: ID M-9423) | |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2023-06-13 |