| NPI | 1487934188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME145317) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 47025) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 004039) | |
| Enumeration Date | 2011-08-25 |
| Last Update Date | 2021-07-27 |