| NPI | 1053384644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 41387) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: GA 041387) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME147583) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD474583) | |
| 2085P0229X Radiology, Pediatric Radiology (Licence: TN 61164) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 61164) | |
| Enumeration Date | 2006-02-13 |
| Last Update Date | 2026-07-06 |