| NPI | 1568453421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WY 12437A) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO DR.0048612) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NE CP463) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G83634) | |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2024-06-17 |