| NPI | 1811945876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX Q0559) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME0083448) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: DE C1-0027345) | |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2024-08-20 |