| NPI | 1710096417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME95248) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25MA05157400) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 101052791) | |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2024-02-15 |