| NPI | 1518349570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME158901) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX T8643) |
| Enumeration Date | 2015-06-25 |
| Last Update Date | 2025-09-15 |