| NPI | 1699193326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD61005677) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO DR.0061966) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: ID M-15222) | |
| Enumeration Date | 2014-03-31 |
| Last Update Date | 2020-12-10 |