| NPI | 1750364717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: ME MD19958) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 73087) |
| 2085B0100X Radiology, Body Imaging (Licence: MA 73087) | |
| Enumeration Date | 2005-11-23 |
| Last Update Date | 2024-07-01 |