| NPI | 1477968584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: WI 71390) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME168389) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: TX U4812) | |
| Enumeration Date | 2014-06-26 |
| Last Update Date | 2024-09-16 |