| NPI | 1730387366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MS 21504) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 246970) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME181995) | |
| Enumeration Date | 2007-07-05 |
| Last Update Date | 2026-06-23 |