| NPI | 1417507740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME172936) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: TX V5139) |
| 2085N0700X (Licence: TX V5139) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX V5139) | |
| Enumeration Date | 2019-09-18 |
| Last Update Date | 2025-07-08 |