| NPI | 1740495654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 57592) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME141863) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 200900452) | |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2020-05-21 |