| NPI | 1689672040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME 92993) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NE 24735) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: OH 35063049) | |
| Enumeration Date | 2005-07-11 |
| Last Update Date | 2022-04-29 |