| NPI | 1811981590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: GA 81276) |
| Additional Taxonomies | 2085B0100X Radiology Body Imaging (Licence: TX K4817) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME99052) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: TX K4817) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: VA 0101265572) | |
| Enumeration Date | 2005-09-08 |
| Last Update Date | 2023-08-11 |