| NPI | 1861458788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 49773) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35082746) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME116705) | |
| Enumeration Date | 2006-04-21 |
| Last Update Date | 2025-03-05 |