| NPI | 1588807606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TN 52690) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: TX V3486) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: DE C1-0027448) | |
| Enumeration Date | 2009-04-20 |
| Last Update Date | 2024-10-31 |