| NPI | 1366419384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME68069) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 224400) |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2026-06-03 |