| NPI | 1083792014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME160050) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 23689) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 29846) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2023-01-27 |