| NPI | 1578563532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME164474) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: DE C10008282) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD029334E) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA06244600) | |
| Enumeration Date | 2005-07-29 |
| Last Update Date | 2024-03-25 |