| NPI | 1548235823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA C54627) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME91437) |
| 2085U0001X Radiology, Diagnostic Ultrasound (Licence: FL ME91437) | |
| Enumeration Date | 2006-02-21 |
| Last Update Date | 2020-02-13 |