| NPI | 1508881442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 53032) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NH 10869) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME132990) | |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2025-01-27 |