| NPI | 1457464786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME125081) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD423472) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: RI MD11832) | |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2024-03-20 |