| NPI | 1750498200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 89412) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2023-00808) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101277884) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 41893) | |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2023-08-01 |