| NPI | 1760668156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101263855) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 002839) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D0087760) | |
| Enumeration Date | 2008-01-15 |
| Last Update Date | 2021-09-13 |