| NPI | 1760707236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X (Licence: VT 042.0013440) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2015-00157) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 38000) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 72630) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME154739) | |
| Enumeration Date | 2010-03-28 |
| Last Update Date | 2022-05-18 |