| NPI | 1689659799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 062288) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 200400748) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: SC MD35557) | |
| Enumeration Date | 2005-12-12 |
| Last Update Date | 2015-04-07 |