| NPI | 1407155328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X (Licence: TX S1029) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX S1029) |
| 2085N0700X (Licence: FL ME146443) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME146443) | |
| Enumeration Date | 2011-03-17 |
| Last Update Date | 2024-09-12 |