| NPI | 1134221765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TN 71491) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME79270) |
| Enumeration Date | 2006-09-03 |
| Last Update Date | 2024-06-19 |