| NPI | 1821432972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0102203944) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: ME DO3597) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2022-00388) | |
| Enumeration Date | 2013-04-19 |
| Last Update Date | 2023-10-30 |