| NPI | 1801831060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME 59081) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NJ 25IA12903700) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 105000) | |
| Enumeration Date | 2006-06-19 |
| Last Update Date | 2026-03-13 |