| NPI | 1649245903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME100717) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD00045843) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MD 61793) | |
| Enumeration Date | 2006-02-21 |
| Last Update Date | 2024-03-12 |