| NPI | 1477715589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 63716) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: CO DR-48016) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: CO 48016) | |
| Enumeration Date | 2008-06-30 |
| Last Update Date | 2021-11-17 |