| NPI | 1194847038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301082568) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME152043) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 75599) | |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2025-10-14 |