| NPI | 1649236431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME0094620) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 57155) |
| Enumeration Date | 2006-04-21 |
| Last Update Date | 2023-12-15 |