| NPI | 1124075122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME89998) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60182987) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME19998) | |
| Enumeration Date | 2006-05-27 |
| Last Update Date | 2024-07-05 |