| NPI | 1578805230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME155034) |
| Additional Taxonomies | 2085N0700X (Licence: FL ME155034) |
| 2085N0700X (Licence: CA A133922) | |
| Enumeration Date | 2013-03-20 |
| Last Update Date | 2022-03-22 |