| NPI | 1750624144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: GA 82867) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: CA A175662) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: DC ME171711) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: TN 59250) | |
| Enumeration Date | 2013-04-03 |
| Last Update Date | 2025-02-03 |