| NPI | 1669521803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME160878) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD439660) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA08912500) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: DE C1-0009667) | |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2023-11-16 |