| NPI | 1942594908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME112370) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 248606) |
| Enumeration Date | 2011-06-07 |
| Last Update Date | 2019-07-01 |