| NPI | 1073518882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME038159) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 36517) |
| Enumeration Date | 2005-06-17 |
| Last Update Date | 2015-08-03 |