| NPI | 1396761748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 29581) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 15196) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME147386) | |
| Enumeration Date | 2006-07-15 |
| Last Update Date | 2026-03-11 |