| NPI | 1689679631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME91391) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AR E0761) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VT 042-0010894) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: LA MD.15599R) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD423498) | |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2021-06-25 |