| NPI | 1588662183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME90378) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: KY 57159) |
| Enumeration Date | 2005-07-08 |
| Last Update Date | 2023-02-22 |