| NPI | 1508860545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: NC 33390) |
| Additional Taxonomies | 2085R0203X Radiology, Therapeutic Radiology (Licence: WI 247085) |
| 2085R0203X Radiology, Therapeutic Radiology (Licence: PA MD-035235-E) | |
| 2085R0001X (Licence: CA G86259) | |
| 2085R0001X (Licence: FL ME-0051462) | |
| Enumeration Date | 2005-06-08 |
| Last Update Date | 2026-01-15 |