| NPI | 1851362396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 53980) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 55619) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME87320) | |
| Enumeration Date | 2006-02-01 |
| Last Update Date | 2020-02-20 |