| NPI | 1609014489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME151240) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: TN 47338) |
| Enumeration Date | 2009-02-02 |
| Last Update Date | 2022-08-01 |