| NPI | 1922394436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 60906) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 67377) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KY C0101) | |
| Enumeration Date | 2011-06-22 |
| Last Update Date | 2022-07-21 |