| NPI | 1164411120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D0103729) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME164367) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35066807) | |
| Enumeration Date | 2005-10-20 |
| Last Update Date | 2025-08-14 |