| NPI | 1568805695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME147411) |
| Additional Taxonomies | 2085N0904X Radiology Nuclear Radiology (Licence: AL 33875) |
| Enumeration Date | 2013-04-08 |
| Last Update Date | 2024-02-01 |