| NPI | 1811995608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME93915) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: DC 21985) |
| 2085B0100X Radiology, Body Imaging (Licence: FL ME93915) | |
| Enumeration Date | 2005-07-14 |
| Last Update Date | 2015-03-02 |