| NPI | 1982054813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA OP61246199) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 5101022742) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MT 107043) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CO DR.0066237) | |
| Enumeration Date | 2016-06-22 |
| Last Update Date | 2022-07-26 |