| NPI | 1366654162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: VA 0101249645) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: GU MC-132) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: NJ 25MA11778200) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME157709) | |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2024-09-13 |