| NPI | 1992786529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA C161971) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 223631) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101244599) | |
| Enumeration Date | 2005-11-10 |
| Last Update Date | 2023-12-22 |