| NPI | 1750359691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CO 45403) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: FL TPME5864) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: NY 208193) | |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2023-10-15 |