| NPI | 1528081460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X (Licence: MI 4301080834) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2012-02111) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 259229) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301080834) | |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2026-05-14 |