| NPI | 1407235880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME129647) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 69384) |
| Enumeration Date | 2015-05-19 |
| Last Update Date | 2023-10-23 |