| NPI | 1700841418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL OS19182) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 5101011753) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 15101011765) | |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2023-03-08 |