| NPI | 1679534663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 52773) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: CO 37431) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: VA 0101240000) | |
| Enumeration Date | 2006-03-29 |
| Last Update Date | 2020-09-03 |