| NPI | 1801175401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2010018032) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GU DOC-032) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: ND 19896) | |
| Enumeration Date | 2011-08-12 |
| Last Update Date | 2024-04-26 |