NPI | 1700801453 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CO 44299) |
Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NE 23559) |
2085R0202X Radiology Diagnostic Radiology (Licence: WY 7425A) | |
2085R0202X Radiology Diagnostic Radiology (Licence: TN MD0000036664) | |
Enumeration Date | 2006-07-13 |
Last Update Date | 2022-07-20 |