| NPI | 1649443524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME119450) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 97523) |
| Enumeration Date | 2008-04-10 |
| Last Update Date | 2025-08-14 |