| NPI | 1265856686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME135302) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 287537) |
| Enumeration Date | 2014-02-05 |
| Last Update Date | 2024-05-24 |