| NPI | 1740254622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD00046029) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 40338) |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2024-03-29 |