| NPI | 1871759654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME119935) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 60455) |
| Enumeration Date | 2008-07-31 |
| Last Update Date | 2024-01-08 |