| NPI | 1366468951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VT 0420011229) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NH 12274) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 200400568) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 2095) | |
| Enumeration Date | 2006-07-15 |
| Last Update Date | 2025-09-09 |