| NPI | 1124085246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME129700) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD427572) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2012-00166) | |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2024-01-08 |