| NPI | 1205811569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 24428) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: VT 042-0011288) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NH 12719) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME93712) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: LA MD200197) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G87423) | |
| Enumeration Date | 2005-12-09 |
| Last Update Date | 2025-12-15 |