| NPI | 1689803355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 46689) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME126787) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2018-03007) | |
| Enumeration Date | 2009-07-02 |
| Last Update Date | 2019-08-21 |