| NPI | 1720245582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME107975) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NY 255618) |
| Enumeration Date | 2008-05-20 |
| Last Update Date | 2015-05-13 |