| NPI | 1124048160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI SP057702) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 83257) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 340654) | |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2025-11-11 |