| NPI | 1235494170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME130192) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 38858) |
| Enumeration Date | 2012-07-06 |
| Last Update Date | 2022-04-20 |