| NPI | 1235170507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: FL ME 98457) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME 98457) |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2025-12-09 |