| NPI | 1881842755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 47652) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 31571) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WY 12013C) | |
| Enumeration Date | 2008-09-04 |
| Last Update Date | 2019-07-08 |