| NPI | 1962781203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MA 265490) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: RI 14337) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: RI MD14337) | |
| Enumeration Date | 2011-08-04 |
| Last Update Date | 2022-01-09 |