| NPI | 1720157753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301104186) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX Q1301) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME130506) | |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2022-12-07 |