| NPI | 1669836292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: GA 88597) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MO 2018009816) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME149470) | |
| Enumeration Date | 2016-04-10 |
| Last Update Date | 2022-08-10 |