| NPI | 1528025673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TN 40098) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME103342) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: KY 39706) | |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2018-11-14 |