| NPI | 1275759565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: FL OS15566) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MI 1635845) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: WV 2315) | |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2024-01-18 |