| NPI | 1134446255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME131483) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AL 35054) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2015007383) | |
| Enumeration Date | 2010-04-29 |
| Last Update Date | 2018-08-14 |