| NPI | 1679524904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CO 37631) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: HI 17633) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: KS 04-34796) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: NE 25241) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: TN 29742) | |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2024-03-31 |