| NPI | 1780911768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 88085) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AL 31011) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MS 20015) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 85446) | |
| Enumeration Date | 2009-11-11 |
| Last Update Date | 2021-09-10 |