| NPI | 1275812489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME151493) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX Q2237) |
| Enumeration Date | 2011-08-05 |
| Last Update Date | 2022-03-29 |