| NPI | 1548231541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 57172) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 169198) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME114352) | |
| Enumeration Date | 2006-01-28 |
| Last Update Date | 2026-03-23 |