| NPI | 1295949220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X (Licence: ND 21276) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI EMC0005197) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX m6990) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101265992) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD493630) | |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2026-05-13 |