| NPI | 1154411882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: ME MD14657) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: VT 042-0014355) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2021-06-24 |