| NPI | 1629211354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME125580) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD450771) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PR 21945) | |
| Enumeration Date | 2009-04-10 |
| Last Update Date | 2022-03-02 |