| NPI | 1548298748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 12043) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA 36569) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 18746) | |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2023-03-07 |