| NPI | 1700838620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 159312) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA MD.204391) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME100882) | |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2020-05-21 |