| NPI | 1811283930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX Q7491) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 5101019560) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: IA DO-04867) | |
| Enumeration Date | 2011-06-27 |
| Last Update Date | 2023-07-28 |