| NPI | 1265495568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME133404) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 230666) |
| Enumeration Date | 2006-04-08 |
| Last Update Date | 2017-10-25 |