| NPI | 1700867835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA 38325) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO DR-48358) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 329898-1205) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OK 25334) | |
| Enumeration Date | 2005-11-07 |
| Last Update Date | 2020-05-18 |