| NPI | 1952987695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME164009) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: FL TRN32322) |
| Enumeration Date | 2021-03-23 |
| Last Update Date | 2023-09-21 |