| NPI | 1497018212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX Q8716) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX BP10043649) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101262422) | |
| Enumeration Date | 2012-06-18 |
| Last Update Date | 2024-06-05 |