| NPI | 1659365765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NM 80-139) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: CO 31381) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: NH 13899) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: TX G4454) | |
| Enumeration Date | 2005-09-02 |
| Last Update Date | 2015-07-15 |