| NPI | 1588616338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME112306) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 200200744) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 264111) | |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2024-10-18 |