| NPI | 1013177120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME135337) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: CO DR.0054157) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: VA 0101246167) | |
| Enumeration Date | 2008-06-11 |
| Last Update Date | 2020-09-03 |