| NPI | 1477576064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD00046825) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD432517) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME100616) | |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2026-07-01 |