| NPI | 1619926664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 33031) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2018032071) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 36345) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 81149) | |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2023-01-26 |