| NPI | 1912149261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO DR.0056205) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OK 5333) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 5101019686) | |
| Enumeration Date | 2009-04-01 |
| Last Update Date | 2019-09-17 |