| NPI | 1902864341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: DC MD600003705) |
| Additional Taxonomies | 2085N0700X (Licence: AZ 22120) |
| 2085N0700X (Licence: FL ME120685) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D0044324) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME120685) | |
| 2085N0700X (Licence: MD D0044324) | |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2025-12-18 |