| NPI | 1760642771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME135951) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD428578) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 234964) | |
| Enumeration Date | 2008-06-12 |
| Last Update Date | 2024-04-23 |