| NPI | 1083904858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 50575) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: CA A124385) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: FL TPME6097) | |
| Enumeration Date | 2011-04-14 |
| Last Update Date | 2023-10-09 |