| NPI | 1033161856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 45144) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME170884) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: ND 22489) | |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2025-07-28 |