| NPI | 1861839144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME138208) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 55889) |
| Enumeration Date | 2013-05-28 |
| Last Update Date | 2020-09-02 |