| NPI | 1003802265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X (Licence: MA 225547) |
| Additional Taxonomies | 2085N0700X (Licence: TX W0351) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME97645) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: DE C1-0025029) | |
| Enumeration Date | 2005-09-23 |
| Last Update Date | 2025-08-12 |