| NPI | 1588603393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 201501777) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301076959) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101260818) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 67766) | |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2023-03-09 |