| NPI | 1891882536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301048787) |
| Additional Taxonomies | 2085N0700X (Licence: FL ME76335) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME76335) | |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2022-10-04 |