| NPI | 1396734430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 14667) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD434952) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME103581) | |
| Enumeration Date | 2005-10-20 |
| Last Update Date | 2026-07-06 |