| NPI | 1871572537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME117510) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 34512) |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2020-08-20 |