| NPI | 1831120146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 200201050) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 28433) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 36750) | |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2023-07-11 |