| NPI | 1467400861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME132576) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35089109) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: LA 305361) | |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2026-03-21 |