| NPI | 1588079917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME144216) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D87278) |
| Enumeration Date | 2014-06-24 |
| Last Update Date | 2025-05-08 |