| NPI | 1891772356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME95580) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MA 220353) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: AL 00027338) | |
| Enumeration Date | 2005-12-27 |
| Last Update Date | 2014-11-12 |