| NPI | 1750360012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL 47232) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD00026303) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 70118) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 62466) | |
| Enumeration Date | 2006-01-13 |
| Last Update Date | 2019-01-22 |