| NPI | 1265671655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME147834) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD454601) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 254025) | |
| Enumeration Date | 2009-02-09 |
| Last Update Date | 2021-01-28 |