| NPI | 1942443676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME106963) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX P5201) |
| Enumeration Date | 2009-04-10 |
| Last Update Date | 2019-10-22 |