| NPI | 1770550667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 200300998) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: NC 200300998) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 27600) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME151334) | |
| Enumeration Date | 2006-03-01 |
| Last Update Date | 2023-07-31 |