| NPI | 1649245085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 64504) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME63918) |
| 174400000X Specialist (Licence: FL ME63918) | |
| Enumeration Date | 2006-02-21 |
| Last Update Date | 2026-07-10 |