| NPI | 1932258852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 55131) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL Me120127) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MT186423) | |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2023-12-13 |