| NPI | 1316920168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME75148) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 200201345) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2003021678) | |
| Enumeration Date | 2005-11-25 |
| Last Update Date | 2016-11-22 |