| NPI | 1346634425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA OS021198) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA FK0135031) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0102205922) | |
| Enumeration Date | 2015-03-26 |
| Last Update Date | 2021-08-27 |