| NPI | 1073584900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 70117) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 209761) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101241822) | |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2023-12-08 |