| NPI | 1669674651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: ID M-15509) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA MD.202833) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 36551) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A107470) | |
| Enumeration Date | 2007-06-03 |
| Last Update Date | 2021-07-02 |