| NPI | 1659318038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX M4468) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 200101991) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OK 21171) | |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2022-09-12 |