| NPI | 1164833117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME160463) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 279116) |
| Enumeration Date | 2014-05-13 |
| Last Update Date | 2024-02-29 |