| NPI | 1659568038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME102778) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 045314) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101251574) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 58110) | |
| Enumeration Date | 2007-09-28 |
| Last Update Date | 2023-07-06 |