| NPI | 1578537890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CO 37883) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NE 25135) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: KS 04-36430) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: HI 17548) | |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2022-12-12 |