| NPI | 1720036312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: SC 91827) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: DE C1-0026778) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 18577) | |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2024-08-20 |