| NPI | 1396958872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME101253) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 16172) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301089594) | |
| 2085B0100X Radiology, Body Imaging (Licence: FL ME101253) | |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2015-02-26 |