| NPI | 1720053036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CO 50837) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MN 47684) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME104506) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: NE 26628) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: WY TL1737) | |
| Enumeration Date | 2006-02-21 |
| Last Update Date | 2013-11-11 |