| NPI | 1093795338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX M8054) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101054381) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME 113022) | |
| Enumeration Date | 2006-01-20 |
| Last Update Date | 2017-04-28 |