| NPI | 1972707545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME114622) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 049774) |
| Enumeration Date | 2007-06-14 |
| Last Update Date | 2022-07-21 |