| NPI | 1598744427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X (Licence: MA 76642) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: RI MD09131) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 76642) | |
| Enumeration Date | 2006-01-10 |
| Last Update Date | 2026-09-01 |