| NPI | 1396108023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NE 30270) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: ME MD28523) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: NH 33521) | |
| Enumeration Date | 2016-03-31 |
| Last Update Date | 2024-08-21 |