| NPI | 1417158387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME162391) |
| Additional Taxonomies | 2085N0904X (Licence: NC 2012-00438) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2012-00438) | |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2025-03-06 |