| NPI | 1275676678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: PR 17620) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MA 227685) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME135298) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: GA 102990) | |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2025-06-04 |