| NPI | 1902880586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME63588) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NJ 25MA11569100) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: IA 30668) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: MD D46158) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: CO DR-33505) | |
| Enumeration Date | 2005-12-06 |
| Last Update Date | 2024-05-23 |