| NPI | 1720202468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX S0853) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 24542) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301513325) | |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2025-01-27 |