| NPI | 1861450736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME164190) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MA 227098) |
| Enumeration Date | 2006-05-02 |
| Last Update Date | 2023-08-21 |