| NPI | 1366707564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX P4916) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME170629) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: ND 21816) | |
| Enumeration Date | 2012-07-13 |
| Last Update Date | 2025-07-09 |