| NPI | 1962479964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 57756) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: FL ME94061) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME94061) | |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2018-10-01 |