| NPI | 1700271285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX V6653) |
| Additional Taxonomies | 2085N0700X (Licence: AZ 56994) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 56994) | |
| 2085N0700X (Licence: FL ME174062) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME174062) | |
| 2085N0700X (Licence: TX V6653) | |
| Enumeration Date | 2015-04-01 |
| Last Update Date | 2025-10-06 |