| NPI | 1962491118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL OS9121) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0102201536) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: SC DO883) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 200401304) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 189847-1) | |
| Enumeration Date | 2005-10-20 |
| Last Update Date | 2024-01-22 |