| NPI | 1295983179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME133869) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MS 763-L) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MT192198) | |
| Enumeration Date | 2008-09-03 |
| Last Update Date | 2024-01-08 |