| NPI | 1962841734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME140058) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX R0482) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA 152323) | |
| 208D00000X General Practice (Licence: TX R0482) | |
| Enumeration Date | 2013-06-14 |
| Last Update Date | 2019-06-26 |