| NPI | 1689712655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME110217) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MD T1860) |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2018-08-15 |