| NPI | 1922256650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME142124) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX 45977) |
| Enumeration Date | 2008-09-06 |
| Last Update Date | 2021-09-03 |