| NPI | 1215010384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: GA 063123) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NC 2009-00665) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: SC 27266) | |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2022-03-30 |