| NPI | 1750709119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301105443) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME175471) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: ND 22748) | |
| Enumeration Date | 2014-04-02 |
| Last Update Date | 2025-08-19 |