| NPI | 1861653735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 52869) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: CO DR.0053621) |
| Enumeration Date | 2008-06-23 |
| Last Update Date | 2020-09-03 |