| NPI | 1386688851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 33029) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 38675) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101265049) | |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2023-07-25 |