| NPI | 1548202385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MS 12472) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME92351) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2026-03-12 |