| NPI | 1821081837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME139281) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 278013) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 95-00174) | |
| Enumeration Date | 2005-08-24 |
| Last Update Date | 2021-02-12 |