| NPI | 1548695521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME136634) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MO 2018008508) |
| Enumeration Date | 2013-09-09 |
| Last Update Date | 2020-05-04 |