| NPI | 1023078987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NV DO1978) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA OS013640) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 5101014730) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: ME DO3620) | |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2023-11-08 |