| NPI | 1790764959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 77443) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: VT 042-0010203) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: ME 016369) | |
| Enumeration Date | 2006-01-16 |
| Last Update Date | 2020-07-21 |