| NPI | 1841713138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PR 025118) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME173471) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2024016798) | |
| Enumeration Date | 2017-07-19 |
| Last Update Date | 2026-08-26 |