| NPI | 1649203316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NM MD2007-0530) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME135576) |
| Enumeration Date | 2006-07-08 |
| Last Update Date | 2025-12-29 |