| NPI | 1083651954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 38160) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME95739) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 54741) | |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2020-09-10 |