| NPI | 1780666560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL 159835) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 27770) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA C51795) | |
| Enumeration Date | 2005-11-16 |
| Last Update Date | 2023-05-22 |