| NPI | 1629130141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME104326) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: FL TRN9159) |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2023-03-02 |