| NPI | 1417158213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X (Licence: MA 234962) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: ME MD27568) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 234962) | |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2025-12-16 |