| NPI | 1811216708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA 138936) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME160412) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX U6017) | |
| Enumeration Date | 2010-05-18 |
| Last Update Date | 2025-05-29 |