| NPI | 1093075194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 83986) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301111229) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 2085R0202X) | |
| Enumeration Date | 2012-05-22 |
| Last Update Date | 2024-05-27 |