| NPI | 1114974060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 044336) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD487584) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME166695) | |
| Enumeration Date | 2006-05-27 |
| Last Update Date | 2025-10-23 |