| NPI | 1619953890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CO 43552) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: HI MD17585) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: KS 04-36349) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: NE 25087) | |
| Enumeration Date | 2005-12-19 |
| Last Update Date | 2022-12-09 |