| NPI | 1891766648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 308024) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA 60103134) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101233076) | |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2024-08-05 |