| NPI | 1699805523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME112119) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN MD0000047175) |
| 2085N0700X (Licence: FL ME112119) | |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2012-07-05 |