| NPI | 1790747921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX P9197) |
| Additional Taxonomies | 2085N0904X (Licence: FL ME172587) |
| 2085N0904X (Licence: TX K7971) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME172587) | |
| Enumeration Date | 2006-04-04 |
| Last Update Date | 2025-04-30 |