| NPI | 1376738138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD496445) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME124994) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2008-00747) | |
| Enumeration Date | 2007-09-13 |
| Last Update Date | 2026-09-11 |