| NPI | 1326007972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX M3269) |
| Additional Taxonomies | 2085N0700X (Licence: TX TEMP) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME170240) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: IL 036169257) | |
| Enumeration Date | 2006-03-22 |
| Last Update Date | 2025-06-23 |