| NPI | 1760532634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 12975467-1205) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101276335) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WY TL2432) | |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2023-12-05 |