| NPI | 1407893894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 34785) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 266752) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME135137) | |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2020-07-14 |