| NPI | 1376536524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: IA 33095) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME137250) |
| Enumeration Date | 2005-08-23 |
| Last Update Date | 2021-06-25 |