| NPI | 1114901386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME160197) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35080391) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OR MD27625) | |
| Enumeration Date | 2005-12-01 |
| Last Update Date | 2026-08-03 |