| NPI | 1457309478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME143672) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: ND 11030) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WY 7348A) | |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2025-12-29 |