| NPI | 1639268253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G76083) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NH 25117) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: ME MD26968) | |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2024-07-02 |