| NPI | 1053386136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 33186) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME117714) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 050011) | |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2026-02-18 |