| NPI | 1649227638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME139974) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 56100) |
| Enumeration Date | 2006-05-27 |
| Last Update Date | 2021-03-03 |