| NPI | 1861656282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X (Licence: FL ME160449) |
| Additional Taxonomies | 2085N0700X (Licence: DE C1-0028030) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: DE C1-0028030) | |
| Enumeration Date | 2008-07-15 |
| Last Update Date | 2025-04-08 |