| NPI | 1902828478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TN 26007) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NC 9600061) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: GA 039973) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME88145) | |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2016-10-13 |