| NPI | 1457643033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME125720) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: GA 101802) |
| Enumeration Date | 2011-05-13 |
| Last Update Date | 2025-04-09 |