| NPI | 1679586234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OR DO22418) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NM A778-83) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OK 2692) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: AK 2705) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 34170) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WV 1459) | |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2007-07-11 |