| NPI | 1801876677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101239501) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 142428) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA AFE73354) | |
| Enumeration Date | 2006-01-18 |
| Last Update Date | 2012-01-09 |