| NPI | 1528045374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CA A71897) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: OH 35086954) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME104546) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: DE C1-0025812) | |
| 2085U0001X Radiology Diagnostic Ultrasound (Licence: CA A71897) | |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2025-08-13 |