| NPI | 1912932005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 69279) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MA 229569) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME110768) | |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2023-07-24 |