| NPI | 1649599630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA MD.205327) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AL 34147) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME143231) | |
| Enumeration Date | 2010-05-31 |
| Last Update Date | 2025-03-10 |