| NPI | 1467763383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME116809) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL TRN16500) |
| Enumeration Date | 2010-06-24 |
| Last Update Date | 2015-02-23 |