| NPI | 1104137181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 65281) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 262451) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CO DR.0056710) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 29177) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WY 10559A) | |
| Enumeration Date | 2010-06-24 |
| Last Update Date | 2019-07-16 |