| NPI | 1851382097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2022-02092) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: ME 015553) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NH 13424) | |
| Enumeration Date | 2005-11-04 |
| Last Update Date | 2022-09-07 |