| NPI | 1710203732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL MFC1767) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2009-01927) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0109542078) | |
| Enumeration Date | 2010-04-15 |
| Last Update Date | 2024-01-19 |