| NPI | 1619166675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME110234) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GU MC-179) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: ND 17134) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2020039265) | |
| Enumeration Date | 2007-10-16 |
| Last Update Date | 2023-12-28 |