| NPI | 1821049420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME123478) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301056350) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2020-07-21 |