| NPI | 1417381211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME139576) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 277689) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX S6540) | |
| Enumeration Date | 2013-08-28 |
| Last Update Date | 2021-06-13 |