| NPI | 1003077090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: RI MD15584) |
| Additional Taxonomies | 2086S0129X (Licence: MA 254554) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MA L-236269) | |
| Enumeration Date | 2008-06-23 |
| Last Update Date | 2026-02-09 |