| NPI | 1588647556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101241407) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NH 20350) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WV 0101241407) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 219126) | |
| Enumeration Date | 2005-11-23 |
| Last Update Date | 2026-01-19 |