| NPI | 1861925745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NV DO3337) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA 20A19591) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 5151009845) | |
| Enumeration Date | 2017-04-06 |
| Last Update Date | 2024-01-23 |