| NPI | 1184621021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MS 17131) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: VT 042.0016510-COMP) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: LA 329611) | |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2026-02-05 |